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DWI Education BD-1
Brian Knaack
2022-08-11T00:29:21-05:00
DWI Education BD-1
What happened during your arrest?
"
*
" indicates required fields
Name
*
First
Middle Initial
Last
Email
*
What is the reason you were stopped?
*
Speeding
Driving too slow
Light(s) not working
Had a wreck
Other Moving violation
Other
In which county did your arrest occur?
*
Did you take a breath test?
*
Yes
No
What was the result?
*
Why was a breath test not taken?
*
Was a blood test taken?
*
Yes
No
What was the result of the blood test?
*
Before my arrest, I was:
*
Check all that apply.
Drinking alcohol after work
Engaged in a recreational activity while using alcohol (or drugs), i.e. ball game, party, work function, etc.
Coping with problems (relationship, work, family, etc.)
Other
I had been using:
*
Check all that apply.
Beer
Wine
Liquor
Marijuana
Opiates
Pills
Methamphetamines
Other
I was with:
*
Check all that apply.
Spouse
Friend(s)
Co-workers
Family
Stranger/Other
Alone
Summarize any other comments about your alcohol/drug usage and the events leading up to your arrest.
Optional
Hidden
Course Date
MM slash DD slash YYYY
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